{"id":17012,"date":"2019-04-21T05:29:44","date_gmt":"2019-04-20T21:29:44","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17012"},"modified":"2019-06-02T06:37:08","modified_gmt":"2019-06-01T22:37:08","slug":"lancet-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-%e5%8c%bb%e9%99%a2%e7%8e%af%e5%a2%83%e6%b8%85%e6%b4%81%e9%9b%86%e6%9d%9f%e6%8e%aa%e6%96%bd%e4%b8%8e%e5%8c%bb%e9%99%a2%e7%9b%b8%e5%85%b3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17012","title":{"rendered":"[Lancet Infect Dis\u53d1\u8868\u8bba\u6587]: \u533b\u9662\u73af\u5883\u6e05\u6d01\u96c6\u675f\u63aa\u65bd\u4e0e\u533b\u9662\u76f8\u5173\u611f\u67d3(REACH): \u4e00\u9879\u591a\u4e2d\u5fc3\u968f\u673a\u8bd5\u9a8c"},"content":{"rendered":"\n

An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial<\/h1>\n\n\n\n

Brett G Mitchell, Lisa Hall, Nicole White,  et al<\/h3>\n\n\n\n

Lancet Infect Dis 2019; 19: 410-418<\/h3>\n\n\n\n

Background \u80cc\u666f<\/h3>\n\n\n\n

The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals.<\/p>\n\n\n\n

\u533b\u9662\u73af\u5883\u662f\u5fae\u751f\u7269\u4f20\u64ad\u7684\u6e90\u5730\u3002\u6539\u8fdb\u6e05\u6d01\u63aa\u65bd\u5bf9\u60a3\u8005\u4e3a\u4e2d\u5fc3\u7684\u9884\u540e\u6307\u6807\u7684\u5f71\u54cd\u5c1a\u4e0d\u6e05\u695a\u3002\u6211\u4eec\u65e8\u5728\u8bc4\u4ef7\u73af\u5883\u6e05\u6d01\u96c6\u675f\u63aa\u65bd\u5bf9\u964d\u4f4e\u533b\u9662\u76f8\u5173\u611f\u67d3\u7684\u6548\u679c\u3002<\/p>\n\n\n\n

Methods \u65b9\u6cd5<\/h3>\n\n\n\n

The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus<\/em>bacteraemia, Clostridium difficile<\/em> infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505.<\/p>\n\n\n\n

REACH\u7814\u7a76\u662f\u4e00\u9879\u5b9e\u6548\u6027\u3001\u591a\u4e2d\u5fc3\u3001\u968f\u673a\u8bd5\u9a8c\uff0c\u5728\u6fb3\u5927\u5229\u4e9a\u768411\u4e2a\u6025\u6027\u75c5\u533b\u9662\u8fdb\u884c\u3002\u5165\u9009\u533b\u9662\u987b\u8bbe\u7f6eICU\uff0c\u4e14\u88ab\u5212\u5b9a\u4e3a\u5927\u533b\u9662\uff08\u516c\u7acb\u533b\u9662\uff09\u6216\u8d85\u8fc7200\u5f20\u4f4f\u9662\u5e8a\u4f4d\uff08\u79c1\u7acb\u533b\u9662\uff09\uff0c\u5e76\u6709\u533b\u9662\u611f\u67d3\u76d1\u6d4b\u9879\u76ee\u3002\u7814\u7a76\u91c7\u7528\u9636\u68af\u8bbe\u8ba1\uff0c\u5e72\u9884\u9636\u6bb5\u4e3a20\u81f350\u5468\u4e0d\u7b49\u3002\u6211\u4eec\u91c7\u7528REACH\u6e05\u6d01\u96c6\u675f\u63aa\u65bd\uff0c\u8fd9\u662f\u4e00\u79cd\u591a\u6a21\u6001\u5e72\u9884\u63aa\u65bd\uff0c\u5f3a\u8c03\u9488\u5bf9\u5e38\u89c4\u6e05\u6d01\u63aa\u65bd\u7684\u4f18\u5316\u4ea7\u54c1\u4f7f\u7528\uff0c\u6280\u672f\u4e0e\u5458\u5de5\u57f9\u8bad\uff0c\u76d1\u6d4b\u7ed3\u679c\u53cd\u9988\u53ca\u4ea4\u6d41\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u533b\u9662\u83b7\u5f97\u6027\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u83cc\u8840\u75c7\uff0c\u96be\u8fa8\u68ad\u72b6\u82bd\u5b62\u6746\u83cc\u611f\u67d3\u53ca\u4e07\u53e4\u9709\u7d20\u8010\u836f\u80a0\u7403\u83cc\u611f\u67d3\u3002\u6b21\u8981\u9884\u540e\u6307\u6807\u5305\u62ec\u7ecf\u5e38\u89e6\u6478\u90e8\u4f4d\u6e05\u6d01\u662f\u5426\u5f7b\u5e95\uff08\u901a\u8fc7\u8367\u5149\u6807\u8bb0\u51dd\u80f6\u8bc4\u4f30\uff09\u3002\u7814\u7a76\u5728\u6fb3\u5927\u5229\u4e9a\u548c\u65b0\u897f\u5170\u4e34\u5e8a\u8bd5\u9a8c\u6ce8\u518c\u7f51\u6ce8\u518c\uff0c\u6ce8\u518c\u53f7ACTRN12615000325505\u3002<\/p>\n\n\n\n

Findings \u7ed3\u679c<\/h3>\n\n\n\n

Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus<\/em> bacteraemia, and 968 C difficile<\/em> infections, for 3\u2008534\u2008439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus<\/em>bacteraemia, and 278 C difficile<\/em> infections, for 1\u2008267\u2008134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0\u00b735 to 0\u00b722 per 10\u2008000 occupied bed-days (relative risk 0\u00b763, 95% CI 0\u00b741\u20130\u00b797, p=0\u00b70340). The incidences of S aureus<\/em> bacteraemia (0\u00b797 to 0\u00b780 per 10\u2008000 occupied bed-days; 0\u00b782, 0\u00b760\u20131\u00b712, p=0\u00b72180) and C difficile<\/em> infections (2\u00b734 to 2\u00b752 per 10\u2008000 occupied bed-days; 1\u00b707, 0\u00b788\u20131\u00b730, p=0\u00b74655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2\u00b707, 1\u00b783\u20132\u00b734, p<0\u00b70001) and bedrooms from 64% to 86% (1\u00b787, 1\u00b768\u20132\u00b709, p<0\u00b70001).<\/p>\n\n\n\n

2016\u5e745\u67089\u65e5\u81f32017\u5e747\u670830\u65e5\u95f4\uff0c\u6211\u4eec\u5bf911\u6240\u533b\u9662\u5b9e\u65bd\u4e86\u6e05\u6d01\u96c6\u675f\u63aa\u65bd\u3002\u5728\u5e72\u9884\u524d\u9636\u6bb5\uff08\u5171\u8ba13534439\u4e2a\u4f4f\u9662\u65e5\uff09\uff0c\u5171\u6709230\u4f8b\u4e07\u53e4\u9709\u7d20\u8010\u836f\u80a0\u7403\u83cc\u611f\u67d3\uff0c362\u4f8b\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u83cc\u8840\u75c7\u53ca968\u4f8b\u96be\u8fa8\u68ad\u72b6\u82bd\u5b62\u6746\u83cc\u611f\u67d3\u3002\u5728\u5e72\u9884\u540e\uff0c\u4e07\u53e4\u9709\u7d20\u8010\u836f\u80a0\u7403\u83cc\u611f\u67d3\u53d1\u751f\u7387\u4ece\u6bcf10000\u4e2a\u4f4f\u9662\u65e50.35\u4f8b\u964d\u4f4e\u52300.22\u4f8b\uff08\u76f8\u5bf9\u5371\u9669\u5ea6 0\u00b763, 95% CI 0\u00b741\u20130\u00b797, p=0\u00b70340\uff09\u3002\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u83cc\u8840\u75c7\uff08\u4ece\u6bcf10000\u4e2a\u4f4f\u9662\u65e50\u00b797\u4f8b\u52300\u00b780\u4f8b\uff1b0\u00b782, 0\u00b760\u20131\u00b712, p=0\u00b72180\uff09\u548c\u96be\u8fa8\u68ad\u72b6\u82bd\u5b62\u6746\u83cc\u611f\u67d3\uff08\u4ece\u6bcf10000\u4e2a\u4f4f\u9662\u65e52\u00b734\u4f8b\u52302\u00b752\u4f8b\uff1b1\u00b707, 0\u00b788\u20131\u00b730, p=0\u00b74655\uff09\u53d1\u751f\u7387\u65e0\u660e\u663e\u53d8\u5316\u3002\u5e72\u9884\u63aa\u65bd\u4f7f\u5f97\u6d74\u5ba4\u4e2d\u7ecf\u5e38\u89e6\u6478\u90e8\u4f4d\u6e05\u6d01\u6bd4\u4f8b\u4ece55%\u589e\u52a0\u523076% (OR 2\u00b707, 1\u00b783\u20132\u00b734, p<0\u00b70001)\uff0c\u5367\u5ba4\u5185\u7ecf\u5e38\u89e6\u6478\u90e8\u4f4d\u6e05\u6d01\u6bd4\u4f8b\u4ece64%\u63d0\u9ad8\u523086% (1\u00b787, 1\u00b768\u20132\u00b709, p<0\u00b70001)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation \u7ed3\u8bba<\/h3>\n\n\n\n

The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice.<\/p>\n\n\n\n

REACH\u6e05\u6d01\u96c6\u675f\u63aa\u65bd\u80fd\u591f\u6210\u529f\u6539\u8fdb\u6e05\u6d01\u5f7b\u5e95\u6027\uff0c\u663e\u8457\u51cf\u5c11\u4e07\u53e4\u9709\u7d20\u8010\u836f\u80a0\u7403\u83cc\u611f\u67d3\u3002\u6211\u4eec\u7684\u7814\u7a76\u4e3a\u533b\u9662\u6e05\u6d01\u653f\u7b56\u4e0e\u884c\u4e3a\u63d0\u4f9b\u4fe1\u606f\uff0c\u5f3a\u8c03\u4e86\u5e38\u89c4\u6e05\u6d01\u53ca\u51fa\u9662\u6e05\u6d01\u7684\u91cd\u8981\u6027\u3002<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

National Health and Medical Research Council (Australia).<\/p>\n","protected":false},"excerpt":{"rendered":"

An environmental cleaning bundle and health-care-associ […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17012"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17012"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17012\/revisions"}],"predecessor-version":[{"id":17014,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17012\/revisions\/17014"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17012"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17012"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17012"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}